Diagnosis and Management of Chylous Ascites

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Abstract

Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis account for about two-thirds of all the cases of CA in Western countries. The diagnosis of CA is based on the distinct characteristic of the ascitic fluid which includes a milky appearance and a triglyceride level of 200 mg/dL. The management consists of identifying and treating the underlying disease process, dietary modification, and diuretics. Treatment with nutritional optimization and management of the underlying etiology are the cornerstones of therapy. When conservative measures fail, other interventions such as octreotide/somatostatin analogues, surgical ligation, embolization and transjugular intrahepatic portosystemic shunt in patients with cirrhosis can be considered.
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乳糜腹水的诊断和治疗
乳糜腹水(CA)是一种罕见的腹水形式,由富含脂质的淋巴渗漏到腹膜腔引起。这通常是由于创伤和淋巴破裂或继发于梗阻的腹膜淋巴压力增加而发生的。CA的潜在病因分为外伤性、先天性、感染性、肿瘤性、术后、肝硬化或心源性。在西方国家,恶性肿瘤和肝硬化约占所有CA病例的三分之二。CA的诊断是基于腹水的明显特征,包括乳白色外观和甘油三酯水平200mg /dL。管理包括识别和治疗潜在的疾病过程,饮食调整和利尿剂。营养优化治疗和潜在病因的管理是治疗的基石。当保守措施失败时,可以考虑其他干预措施,如奥曲肽/生长抑素类似物、手术结扎、栓塞和经颈静脉肝内门静脉分流术。
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